By: Patricia Hudak, RN and Chelsea Cassidy, LCSWStephanie Meyer is a registered nurse and has been with AT Home Care since 2018. Her nursing career began in 2003 as a Patient Care Technician in the hospital emergency room with Bon Secours Hospital. Stephanie had a front row seat in this position to see how people were dying, and she knew it could be better. Stephanie applied for several transfers within the hospital and was uncertain which unit she wanted to be on however she did know that she wanted the dying process to be different. After speaking with her boss, she transitioned to a hospice RN Case Manager 14 years ago. Stephanie began educating the medical field and community on hospice and focusing on how people should have a dignified and peaceful death. She has great compassion for quality of life and individuals experiencing a comfortable death. A hospice admission nurse is usually the first clinician that the patient or family will meet. The patient or family will often have an initial conversation about hospice with a marketer or intake coordinator and once they are ready to be evaluated by a nurse for hospice criteria, the admission RN is sent to meet the patient. There are three main factors to be considered when a patient is being admitted to hospice: (a) a doctor’s order for hospice evaluation and treatment needs to be obtained, (b) the patient needs to meet hospice criteria based on their terminal diagnosis, and (c) the patient/family needs to agree to the hospice philosophy and plan of care (Medicare). The admission nurse is the storyteller – they are collecting bits and pieces of a patient’s story and helping them see an option to transition from curative care to palliative care. Stephanie takes each individual story and translates it into a beginning point of care for the entire hospice team. An admission nurse is collecting the medical, emotional, psychosocial, and spiritual aspects of a patients care. Stephanie takes this personalized story and turns it into a picture that is not necessarily black or white but filled with parts of gray.
Stephanie beautifully stated, “The medical field, especially hospice, is not black or white. It is often gray, and I have learned that gray is a very pretty color.”Stephanie is very thorough in her evaluation and patient assessment. During this time frame, she is providing education to the patient, family, and the facility staff if a patient resides in a facility. Stephanie provides active listening which helps to build trust as this is often a big decision for a patient to make about their health. Part of Stephanie’s role includes completing hospice admission consent paperwork, educating on hospice, calling in medications and DME, and also obtaining approval from the Medical Director and the family if they are not present. Since COVID-19, many families are limited in being able to see their loved ones, especially in a facility. Stephanie often goes above and beyond to help connect the patient and family with one another. Non-admits can occur when the patient/family are not quite ready for comfort care. Their mindset and goals are focused on curative treatments or aggressive options. Families may be experiencing denial and see hospice as a last resort rather than the quality of life it can provide with pain management, physical, and psychosocial support. Alzheimer’s and dementia diagnosis is one of the top five admission diagnoses for hospice. Showing decline for hospice eligibility can be a challenge for the admission nurse. Stephanie works closely with the Intake Department as they have the initial conversation with the patient/family and will obtain the necessary orders and medical information to determine a patient’s eligibility. Stephanie works a seven on / seven off shift Wednesday-Tuesday 9pm-7pm. This allows her to complete multiple admissions throughout the day. Self-care can be a challenge for people, especially those that are working as a caregiver, such as a nurse. Stephanie practices self-care by “wiping her feet at the door.” She has promised herself to never sacrifice herself spiritually. She remains mentally and emotionally prepared for each admission by being fully present in the moment. When she ends her documentation and sends her report, she accepts her part is complete to the best of her ability. Stephanie is reliable, compassionate, genuine, and accountable. She has served AT Home Care Hospice in numerous ways. She courageously went out to take care of patients that were COVID positive without hesitation in the very beginning of the pandemic. She voiced this is her calling, and when she became a nurse, it was in good times and even during unknown pandemic times. She consistently shows up to work daily with a positive attitude and a heart to serve regardless of the circumstance.